title: Death or survival from invasive pneumococcal disease in Scotland: associations with serogroups and multilocus sequence types.
abstract: We describe associations between death from invasive pneumococcal disease (IPD) and particular serogroups and sequence types (STs) determined by multilocus sequence typing (MLST) using data from Scotland. All IPD episodes where blood or cerebrospinal fluid (CSF) culture isolates were referred to the Scottish Haemophilus, Legionella, Meningococcal and Pneumococcal Reference Laboratory (SHLMPRL) from January 1992 to February 2007 were matched to death certification records by the General Register Office for Scotland. This represented 5959 patients. The median number of IPD cases in Scotland each year was 292. Deaths, from any cause, within 30 days of pneumococcal culture from blood or CSF were considered to have IPD as a contributing factor. Eight hundred and thirty-three patients died within 30 days of culture of Streptococcus pneumoniae from blood or CSF [13.95 %; 95 % confidence interval (13.10, 14.80)]. The highest death rates were in patients over the age of 75. Serotyping data exist for all years but MLST data were only available from 2001 onward. The risk ratio of dying from infection due to particular serogroups or STs compared to dying from IPD due to all other serogroups or STs was calculated. Fisher's exact test with Bonferroni adjustment for multiple testing was used. Age adjustment was accomplished using the Cochran-Mantel-Haenszel test and 95 % confidence intervals were reported. Serogroups 3, 11 and 16 have increased probability of causing fatal IPD in Scotland while serogroup 1 IPD has a reduced probability of causing death. None of the 20 most common STs were significantly associated with death within 30 days of pneumococcal culture, after age adjustment. We conclude that there is a stronger association between a fatal outcome and pneumococcal capsular serogroup than there is between a fatal outcome and ST.
authors.affiliation: Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, 120 University Place, Glasgow G12 8QQ, UK.
authors.forename: Donald
authors.initials: D
authors.lastname: Inverarity
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Lamb
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcal and Pneumococcal Reference Laboratory (SHLMPRL), Stobhill General Hospital, Glasgow G21 3UW, UK.
authors.forename: Mathew
authors.initials: M
authors.lastname: Diggle
authors.affiliation: Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK.|Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK.
authors.forename: David
authors.initials: D
authors.lastname: Greenhalgh
authors.affiliation: Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, 120 University Place, Glasgow G12 8QQ, UK.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Mitchell
authors.affiliation: College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Southampton NIHR Respiratory Biomedical Research Unit, Southampton SO16 6YD, UK.|Health Protection Agency, Southampton SO16 6YD, UK.|Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton SO16 6YD, UK.
authors.forename: Johanna M C
authors.initials: JMC
authors.lastname: Jefferies
authors.affiliation: Southampton NIHR Respiratory Biomedical Research Unit, Southampton SO16 6YD, UK.|Health Protection Agency, Southampton SO16 6YD, UK.|Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton SO16 6YD, UK.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Clarke
authors.affiliation: Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: McMenamin
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcal and Pneumococcal Reference Laboratory (SHLMPRL), Stobhill General Hospital, Glasgow G21 3UW, UK.
authors.forename: Giles F S
authors.initials: GFS
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000401:mortality*; D012606:Scotland / Q000453:epidemiology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000302:isolation & purification*; D016019:Survival Analysis; D055815:Young Adult